The way maternity care in England is organised is not “fit for purpose” and units may have to close to consolidate services, NHS bosses have said.

NHS leaders are calling for a “thorough appraisal” of maternity services, warning that up to 20 units could close. 

The NHS Alliance, which represents organisations across the health and care system, says the current configuration of maternity care across England is not fit for purpose, with particular pressure on smaller units in rural and coastal areas. Outdated, decaying buildings and not enough staff mean that some units are unable to keep up with the marked increase in medical interventions during births, particularly C-sections, making them potentially unsafe. 

Up to 20 out of 155 consultant-led maternity units in England could be closed, the Alliance said. Those delivering between 1,500 and 2,000 babies may be particularly scrutinised, leaders added. 

The viability of smaller units also depends on factors such as neonatal capacity, the availability of specialist staff and whether on-call rotas can be sustained. 

Difficult decisions lie ahead in order to “consolidate maternity services to support safer, more sustainable care”, said Matthew Hopkins, the director of the NHS Alliance’s acute and ambulance network. The way maternity care is delivered “has moved on”, he argued, with the rise in C-sections in particular affecting capacity and staffing.  

In five years, the number of births by C-section has risen by more than 10%, from 33% to 45% in 2025. 

Alternative options far safer

The intervention comes as the national maternity and neonatal taskforce prepares an action plan to tackle failings in the system, as highlighted in the report from Valerie Amos, Baroness Amos. 

The NHS Alliance says difficult decisions are “inevitable” in the interest of patient safety and to address inequalities, particularly worse outcomes in deprived communities and raised mortality rates for Black and Asian women. 

Local plans must involve NHS leaders, clinical staff, patients and communities, Hopkins said, adding that local and national politicians have a “key role to play”. 

“They must have the courage to make the case for patient safety, offering air cover for change,” he said. 

However, midwives and obstetricians have criticised the calls to consolidate maternity services, arguing that care should not be moved further away from expectant mothers.

“We must ensure there are high-quality services close to home,” said Hannah Leonard, chief policy officer of the Royal College of Midwives.

Alison Wright, president of the Royal College of Obstetricians and Gynaecologists, said there are other solutions to the workforce challenges described that are “far safer” than closing maternity units. 

Wright has called for the government to expand the maternity workforce, with investment in training and retention of staff.